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Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience

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Abstract

Purpose

To investigate a benefit from virtual monoenergetic reconstructions (VMIs) for assessment of arterially hyper-enhancing liver lesions in phantom and patients and to compare hybrid-iterative and spectral image reconstructions of conventional images (CI-IR and CI-SR).

Methods

All imaging was performed on a SDCT (Philips Healthcare, Best, The Netherlands). Images of a non-anthropomorphic phantom with a lesion-mimicking insert (containing iodine in water solution) and arterial-phase images from contrast-enhanced patient examinations were evaluated. VMIs (40–200 keV, 10 keV increment), CI-IR, and CI-SR were reconstructed using different strengths of image denoising. ROIs were placed in lesions, liver/matrix, muscle; signal-to-noise, contrast-to-noise, and lesion-to-liver ratios (SNR, CNR, and LLR) were calculated. Qualitatively, 40, 70, and 110 keV and CI images were assessed by two radiologists on five-point Likert scales regarding overall image quality, lesion assessment, and noise.

Results

In phantoms, SNR was increased threefold by VMI40keV compared with CI-IR/SR (5.8 ± 1.1 vs. 18.8 ± 2.2, p ≤ 0.001), while no difference was found between CI-IR and CI-SR (p = 1). Denoising was capable of noise reduction by 40%. In total, 20 patients exhibiting 51 liver lesions were assessed. Attenuation was the highest in VMI40keV, while image noise was comparable to CI-IR resulting in a threefold increase of CNR/LLR (CI-IR 1.3 ± 0.8/4.4 ± 2.0, VMI40keV: 3.8 ± 2.7/14.2 ± 7.5, p ≤ 0.001). Subjective lesion delineation was the best in VMI40keV image (p ≤ 0.01), which also provided the lowest perceptible noise and the best overall image quality.

Conclusions

VMIs improve assessment of arterially hyper-enhancing liver lesions since they increase lesion contrast while maintaining low image noise throughout the entire keV spectrum. These data suggest that to consider VMI screening after arterially hyper-enhancing liver lesions.

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Abbreviations

VMI:

Virtual monoenergetic image

DECT:

Dual-energy computed tomography

DSCT:

Dual-source computed tomography

SDCT:

Spectral detector computed tomography

CI-IR:

Conventional images reconstructed with an hybrid-iterative reconstruction algorithm

CI-SR:

Conventional images reconstructed with the spectral reconstruction algorithm

LLR:

Lesion-to-liver ratio

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    N. Große Hokamp, A. J. Höink, J. Doerner, T. Persigehl, D. Maintz & S. Haneder

  2. Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA

    N. Große Hokamp & D. W. Jordan

  3. Department of Radiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    N. Große Hokamp & D. W. Jordan

  4. Philips Clinical Science CT, Hamburg, Germany

    G. Pahn

Authors
  1. N. Große Hokamp
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Corresponding author

Correspondence to N. Große Hokamp.

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Funding

No funding were received for this study.

Conflict of interest

GP is an employee of Philips Healthcare. DM received reimbursements for talks outside this specific project from Philips Healthcare. NGH, AJH, JD, DWJ, TP, and SH all declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board approved this study and waived informed consent due to the retrospective study design.

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This article does not contain any studies with animals performed by any of the authors.

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Große Hokamp, N., Höink, A.J., Doerner, J. et al. Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience. Abdom Radiol 43, 2066–2074 (2018). https://doi.org/10.1007/s00261-017-1411-1

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